Health bill will let more GPs say “buy my services or go without”

People are rightly angry about the recent report of GPs near York sending letters to their patients offering minor surgical procedures for payment. Unfortunately this is an indication of how things will be in the new NHS: healthcare according to ability to pay. Roy Lilley broke the story and it is well worth reading his article.

(1) The Secretary of State must provide throughout England, to such extent as he considers necessary to meet all reasonable requirements:

(a) hospital accommodation,

(b) other accommodation for the purpose of any service provided under this Act,

(c) medical, dental, ophthalmic, nursing and ambulance services,

(d) such other services or facilities for the care of pregnant women, women who are breastfeeding and young children as he considers are appropriate as part of the health service,

(e) such other services or facilities for the prevention of illness, the care of persons suffering from illness and the after-care of persons who have suffered from illness as he considers are appropriate as part of the health service,

(f) such other services or facilities as are required for the diagnosis and treatment of illness.

(1) A clinical commissioning group must arrange for the provision of the following to such extent as it considers necessary to meet the reasonable requirements of the persons for whom it has responsibility:

(a) hospital accommodation,

(b) other accommodation for the purpose of any service provided under this Act,

(c) medical, dental, ophthalmic, nursing and ambulance services,

(d) such other services or facilities for the care of pregnant women, women who are breastfeeding and young children as the group considers are appropriate as part of the health service,

(e) such other services or facilities for the prevention of illness, the care of persons suffering from illness and the after-care of persons who have suffered from illness as the group considers are appropriate as part of the health service,

(f) such other services or facilities as are required for the diagnosis and treatment of illness.

This transfers the responsibility of deciding the healthcare that the NHS will provide from the Secretary of State to the local Clinical Commissioning Group (CCG). Look at the words: "for the provision of the following to such extent as it considers necessary to meet the reasonable requirements". This is extremely weak. It does not say that the CCG will meet the medical needs of the population it covers, it just says "reasonable requirements" that "it considers necessary".

So effectively the local CCG can decide what medical services the NHS will pay for and what it will not pay for. Every GP practice has to be a member of a CCG. The GPs in a CCG determine who will be on the board and the board determine what the CCG policies will be, including which services they consider necessary.

Roy Lilley supplies a copy of the letter (pdf) that the Haxby GPs have sent to their patients. It states "minor surgical procedures … [are] no longer paid for by the NHS" and includes a tariff for buying eight such treatments privately. But the Guardian says that the local PCT, NHS North Yorkshire and York, routinely fund three of the eight procedures listed. This is an indication of the future of the NHS: GPs will decide that the NHS will not provide certain medical procedures and then offer to perform the procedures privately. This is an abuse of trust and a conflict of interest, and must be outlawed.

A simple amendment to the Bill will stop this happening: delete clause 10 of the Bill so that Clinical Commissioning Groups do not have the responsibility of determining what services the NHS will pay for and what services they can offer privately.